IAJPS 2020, 07 (09), 1091-1098 Laiba Rao et al ISSN 2349-7750

CODEN [USA]: IAJPBB ISSN : 2349-7750

INDO AMERICAN JOURNAL OF

PHARMACEUTICAL SCIENCES
SJIF Impact Factor: 7.187
http://doi.org/10.5281/zenodo.4060784

Available online at: http://www.iajps.com Research Article

RELATIONSHIP OF BODY MASS INDEX WITH MORTALITY

AND MORBIDITY AMONG THE ELDERLY PATIENTS
1Dr.
Laiba Rao, 2Dr. Moazzam Ali, 3Dr. Muhammad Ahmad Rao,
1
CNIC # 36201-4321322-8., 2PMDC# 69036-P., 3PMDC # 109337-P.
Article Received: July 2020 Accepted: August 2020 Published: September 2020
Abstract:
Objective: Obesity may cause many chronic illnesses. Several studies have shown that high body mass index is
associated with mortality and morbidity among the elderly. Therefore, obesity or being overweight could adversely
affect the performance of activities of daily living. In this study our aim was to investigate the association between
Body Mass Index and Activity of Daily Living in Homecare Patients.
Method: The records of 2016 from the homecare unit of Allied hospital faisalabad. During this period, 1105
patients visited this facility. Unconscious or bedridden patients (hemiplegia, hemiparesia, and tetraparesis) and
patients with incomplete data were excluded from the study. Therefore, the survey was completed with 250 files,
which included all the data needed for our research. Age, gender, Body Mass Index and Barthel Index scores were
recorded to the statistical program; p≤0.05 was considered as statistically significant.
Results: One hundred fifty one (60.4%) were women, and 99 (39.6%) were men. The relations between gender and
age, weight, and Barthel index scores were not statistically significant. There was a significant positive correlation
between weight and Barthel index scores as well as between Body Mass Index and
Barthel index scores (r = 0.190; p = 0.003). The patients were divided into two groups: Group-I (underweight and
normal weight) and Group-II (overweight and obese). Group-II exhibited a much higher ability to perform Activity
of Daily Living than Group-I (p = 0.002).
Conclusion: Some studies report that obesity is protective against Activity of Daily Living, but the opposite is
reported in some others. Our study showed increased values of Body Mass Index and Activity of Daily Living ability,
which are indicative of protective effects. The relationship between Body Mass Index and physical disability is not
yet proven to be linear.
Keywords: Aged, Body Mass Index, Homecare Patient, Homecare Services, Obesity, Quality of Life.
Corresponding author:
Dr. Laiba Rao, QR code
CNIC # 36201-4321322-8. Email:star920@yahoo.com

Please cite this article in press Laiba Rao et al, Relationship Of Body Mass Index With Mortality And Morbidity Among The
Elderly Patients., Indo Am. J. P. Sci, 2020; 07(09).

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 IAJPS 2020, 07 (09), 1091-1098
INTRODUCTION:
Overweight or obesity may cause many chronic
illnesses. Furthermore, several studies have shown
that high body mass index (BMI) is associated with
mortality and morbidity among the elderly. [1]
Mobility is another important topic in relation to the
elderly. Difficulties in mobility are often the first sign
of functional decline and may indicate the need for
preventive measures. [2] Mobility problems have
been reported as a predictor of all-cause mortality,
and patients with BMI >30 kg/m2 have low scores in
the “Time Up to Go” test, which assesses mobility.
[3] Mobility problems as well as illnesses leading to
cognitive impairment are a cause of dependence.
Weight loss through diet may be associated with
cognitive improvement in patients with mild
cognitive impairment. [4] Therefore, obesity or being
overweight could adversely affect the performance of
activities of daily living (ADLs).
Barthel index is a simple index of independence,
which is used to score the patients’ ability to perform
ADLs. Since 1955, this index has been used in
hospitals for patients with chronic diseases.[5] The
• Underweight
• Normal range
• Overweight
• Obese
Fig.1: Distribution of age groups according to gender.
Age, gender, chronic diseases, BMI, and Barthel
index scores were analyzed using a statistical
program. According to the Shapiro–Wilk test, our
study population had an abnormal distribution (p <
0.001). The Mann–Whitney U test was used to
compare independent variables between groups. Chi-
square was used to analyze relations between two
non-continuous variables; for continuous variables,
the correlation test was used. P ≤ 0.05 was considered
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Laiba Rao et al ISSN 2349-7750
Barthel index comprises 10 items, including the
presence or absence of fecal and urinary incontinence
and the need for assistance with grooming, toilet use,
feeding, transfers (e.g., from chair to bed), walking,
dressing, climbing stairs, and bathing. In this study,
we investigated the association between BMI and
ADLs in homecare patients.
METHODS:
The records for the period between 01 January 2016
and 31 December 2016 from the homecare unit of
Allied hospital faisalabad was retrospectively
reviewed. During this period, 1105 patients visited
this facility. Unconscious or bedridden patients
(hemiplegia, hemiparesia, and tetraparesis) and
patients with incomplete data were excluded from the
study.
Therefore, the survey was completed with 250 files,
which included all the data needed for our research.
BMI is defined as the body mass divided by the
square of the body height, is universally expressed in
units of kg/m2, and is classified as follows.
<18.50 kg/m2
18.50 ≤ X ≤ 24.99 kg/m2
≥25.00 kg/m2
≥30.00 kg/m2
statistically significant.
RESULTS:
Two hundred fifty patients were included in our
study: 151(60.4%) were women and 99 (39.6%) were
men. The patient age groups and gender distributions
are shown in Fig.1. The number of women aged >65
years was much greater than that of men, and
hypertension was the most commonly occurring
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chronic disease (n = 173; 60%; Fig.2).
Age, weight, height, BMI, and Barthel index scores
stratified by gender are shown in Fig.3. The relations
between gender and age, weight, and Barthel index
scores were not statistically significant (p = 0.050,
0.538, and 0.587, respectively). However, The
Barthel index was used as a screening tool to assess
the ability to perform ADLs. The Barthel index
scores are in multiples of five, ranging from 0
(completely dependent) to 100 (independent in
basic). Higher scores represent a higher degree of
independence were taller than the women (p =
0.000), and the women had higher BMIs than the
men (p = 0.000).

The Barthel index scores are classified as follows:

• 0–20 points: total dependency
• 21–60 points: high-level dependency
• 61–90 points: mid-level dependency
• 91–99 points: low-level dependency
• 100 points: total independence Fig.2: Distribution of chronic diseases.

Fig.3: Age, weight, height, BMI and Barthel index scores stratified by gender.

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Gender-based comparisons revealed significant
correlations between BMI and Barthel index scores
only among women (r = 0.299; p = 0.00).
There were significant negative correlations between
age and weight, height, Barthel index scores (i.e.,
when age increased, the weight, height, and Barthel
index scores decreased). Table-I There was a
significant positive correlation between weight and
Barthel index scores as well as between BMI and
Barthel index scores (r = 0.190; p = 0.003). Therefore,
when age increased, weight, BMI, Barthel index
scores, and ability to perform ADLs decreased.
All the items of the Barthel index were not correlated
with BMI. Assistance with feeding, toilet use,
dressing, climbing stairs, bathing, and walking as well
as urinary and fecal continence were positively
correlated with BMI. As shown in Table-II, need for
assistance with grooming and need for transfers (e.g.,
from chair to bed) using a wheelchair were not
correlated.
According to their BMIs, the patients were classified
as underweight (n = 10; 4%), normal weight (n = 125;
50%), overweight (n = 76; 30.4%), and obese (n = 39;
15.6%). The mean Barthel index scores stratified by
BMI were as follows: underweight, 26.50 ± 20;
normal weight, 22.93 ± 27.13; overweight, 31.51 ±
31.86, and obese, 42.30 ± 31.28. The patients were
divided into two groups: Group-I (underweight and
normal weight) and Group-II (overweight and obese).
Group-II exhibited a much higher ability to perform
ADLs than Group-I (p = 0.002).In addition, 28
(11.2%) of our patients died in 2016, 15 (53.6%) of
whom were women. We identified no relation between
death and gender (p = 0.433). Furthermore, there was
no relation between death and age, BMI, and Barthel
index scores (p = 0.482, 0.737, and 0.288,
respectively).
DISCUSSION:
According to the World Health Organization, 71.4
years (males: 69.1 years; females: 73.7 years) is the
average life expectancy at birth, and the life
expectancy over the age of 60 years was 20.4 years
(males: 18.9 years; females: 21.7 years) among the
global population in 2015.6 In Turkey, the life
expectancy at birth is 66.2 years.6 According to our
national statistics, the elderly population was
6,651,503 in 2016 and accounted for 8.3% of

Table-I: Correlations among age, weight, height, BMI, and Barthel index scores.

Correlations

Pearson Correlation
Age 1 - - - -
Sig. (2-tailed)
Pearson Correlation -0.183**
Weight 1 - - -
Sig. (2-tailed) 0.004
Pearson Correlation -0.207** 0.416**
Height - - -
Sig. (2-tailed) 0.001 0.000
Pearson Correlation -0.111 0.898** 0.032
BMI 1 -
Sig. (2-tailed) 0.080 0.000 0.612
Pearson Correlation -0.149* 0.163* 0.037 0.190**
Barthel Index 1
Sig. (2-tailed) 0.019 .010 0.565 0.003
Age Weight Height BMI Barthel Index

**. Correlation is significant at the 0.01 level (2-tailed). *. Correlation is significant at the 0.05 level (2-tailed).

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Table-II: Correlations between items of the Barthel index and BMIs.

Sig. (2-tailed) - - - - - -
Pearson
Correlation 0.780** 1 - - - -
NT
Sig. (2-tailed) 0.000 - - - - -
Pearson 0.641*
Correlation 0.713** *
1 - - -
G
Sig. (2-tailed) 0.000 0.000 - - -
Pearson 0.575* 0.627*
Correlation 0.661** * *
1 - -
T
Sig. (2-tailed) 0.000 0.000 0.000 - -
Pearson 0.410* 0.363* 0.608*
Correlation 0.385** * * *
-
B 1
Sig. (2-tailed) 0.000 0.000 0.000 0.000 -
Pearson 0.286* 0.542* 0.577* 0.473*
Correlation 0.450** * * * *
1
W
Sig. (2-tailed) 0.000 0.000 0.000 0.000 0.000
Pearson −0.09 0.296* −0.15
Correlation 0.146* 0.093 6 *
0.014 1*
WC
Sig. (2-tailed) 0.021 0.142 0.129 0.000 0.828 0.017
Pearson 0.356* 0.379* 0.644* 0.517* 0.542
Correlation 0.429** * * * * **

CS
Sig. (2-tailed) 0.000 0.000 0.000 0.000 0.000 0.000
Pearson 0.560* 0.650* 0.836* 0.591* 0.623
Correlation 0.669** * * * * **

D
Sig. (2-tailed) 0.000 0.000 0.000 0.000 0.000 0.000
Pearson 0.652* 0.653* 0.754* 0.570* 0.531
Correlation 0.802** * * * * **

UC
Sig. (2-tailed) 0.000 0.000 0.000 0.000 0.000 0.000
Pearson 0.658* 0.628* 0.779* 0.585* 0.499
Correlation 0.791** * * * * **

FC
Sig. (2-tailed) 0.000 0.000 0.000 0.000 0.000 0.000
Pearson 0.168* 0.223* 0.251
Correlation 0.138* 0.009 * *
0.106 **
Bmı Sig. (2-tailed) 0.029 0.886 0.008 0.000 0.095 0.000
N 250 250 250 250 250 250
Feeding NT G T B W

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- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
- - - - - -
1 - - - - -
- - - - -
0.194** 1 - - - -
0.002 - - - -
0.236** 0.701** 1 - - -
0.000 0.000 - -
0.214** 0.620** 0.805** 1 - -
0.001 0.000 0.000 - -
0.253** 0.632** 0.788** 0.902** 1 -
0.000 0.000 0.000 0.000 -
0.092 0.103 0.183** 0.143* 0.164** 1
0.146 0.104 0.004 0.023 0.009
250 250 250 250 250 250
WC CS D UC FC BMI

**. Correlation is significant at the 0.01 level (2-tailed) *. Correlation is significant at the 0.05 level (2-tailed). Help
needed with feeding (F), transfers (NT), grooming (G), toilet use (T), bathing (B), walking (W), wheelchair use
(WC), climbing stairs (CS), and dressing (D) as well as fecal continence (FC) and urinary continence (UC).

All populations (males: 43.9%; females: 56.1%). [7]
Similarly, 60.4% of our study group was female,
which is probably the result of the longer life
expectancy of women.
According to the Turkey Statistical Institute, 61.5%
of the elderly population are in the age group of 65–
74 years, 30.2% are in the age group of 75–84 years,
and 8.2% are in the age of ≥85 years. [8]
Several studies have shown that most homecare
patients are aged >65 years. [9,10] In our study,
16.6% of the elderly population was in the age group
of 65–74 years, 39.3% were in the age group of 75–
84 years, and 44.1% were in the age group of ≥85
years. These findings are because the need for
homecare increases with age; accordingly, most of
our study population was aged >85 years.
incurable. The World Health Organization has listed
cardiovascular accidents (stroke), cancer, chronic
obstructive pulmonary disease, and diabetes as the
most prevalent chronic illnesses worldwide.11
According to the cause of death statistics in Turkey,
46.3% of elderly people died from circulatory system
diseases in 2015. [8] In a study of a 3-year (2003–
2006) Canadian homecare data, the most frequent
chronic illness among 149,378 long-term homecare
patients was chronic renal disorder, followed by
hypertension, diabetes, heart failure, and
depression.12 A study in Turkey revealed that
hypertension was detected in 41.8% of homecare
patients. [13] In our study, hypertension was the most
frequently observed chronic disease (n = 173; 60%).
Moreover, hypertension is observed 30%–45% of the
general population, and this percentage increases
with age. [14]

Chronic illnesses are long-term illnesses and usually The prevalence of overweight and obesity is

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 IAJPS 2020, 07 (09), 1091-1098 Laiba Rao et al
increasing in the elderly population. [15] Obesity is
known to have a negative effect on mortality and
morbidity. [16,17] Numerous cohort studies have
reported that higher levels of frailty are predicted by
not only cognitive impairment but also various
frailty-related indicators such as BMI and ADL-
performing ability. [18,19] However, we identified a
positive correlation between BMI and ADL-
performing ability in our population. Similarly, we
obtained controversial results for whether overweight
increases the ADL disability [20] or has protective
effects. [21] This is because ADL-performing ability
changes with not only weight but also eating habits,
and the eating habits of overweight or obese
individuals may decrease the malnutrition risk and
may protect against the decline of ADL ability, given
that nutritional status is related to ADL-performing
ability in geriatric patients. [22].
Overweight and obesity, as measured by BMI, are
also associated with a higher probability of ADL
disability among women but not men. [23] By
contrast, our study showed that ADL-performing
ability in women positively correlated with BMI.
This is because elderly individuals lose
approximately 1% of their lean mass (mainly muscle
mass) per /year, with men losing more muscle mass
than do women, both in absolute and relative terms.
[24] Hence, increased BMI led to increased ADL-
performing ability among women in our study.
Many studies have shown that sarcopenia which is
one of the main problems in the elderly, is associated
with the decline in muscle mass and strength and is a
predictor of poor outcomes, including mortality,
disability, and poor quality of life. [24] Malnutrition
and weight loss are the causes of sarcopenia which is
associated with functional dependence in the elderly.
[25] Accordingly, in our study, when the BMI
decreased, the ADL-performing ability decreased,
possibly because of the slowing down of activity due
to malnutrition or sarcopenia.
CONCLUSION:
The relationship between obesity and ADL in the
literature is unclear. Some studies report that obesity
is protective against ADL, but the opposite is
reported in some others. In our study showed
increased values of BMI and ADL ability, which are
indicative of protective effects. The relationship
between BMI and physical disability is not yet
proven to be linear. This is because underweight and
obesity have similar risks. Accordingly, we conclude
that overweight, obesity, and female gender are
associated with an increase in ADL-performing
ability in some cases. In general, physicians can
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ISSN 2349-7750
advise all patients to receive adequate nutrition and
perform exercises, which will protect them from most
chronic diseases and help them with healthy aging.
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